Your patient has had hypertension for 10 years, a myocardial ...

[gbarreiro]

Your patient has had hypertension for 10 years, a myocardial infarction 5 years ago, and now complains of dyspnea on exertion, cough, and 3-pillow orthopnea. Which of the following conditions is likely?
 
  A. Right ventricular failure
  B. Pulmonary embolism
  C. Cor pulmonale
  D. Left ventricular failure

Question 2

Your 47-year-old female patient has a waist to hip ratio of 1. In terms of cardiovascular disease risk, this is considered:
 
  A. Ideal
  B. Greater than acceptable limits
  C. Less than acceptable limits
  D. Within acceptable limits

[Jmfn03]

Answer to Question 1

ANS: D
Left ventricular failure is most commonly characterized by dyspnea on exertion, cough, fatigue, orthopnea, PND, cardiac enlargement, crackles, gallop rhythm, and pulmonary congestion. Right ventricular failure is commonly characterized by dependent edema, elevated venous pressure, hepatomegaly, and possibly ascites. Pulmonary embolism presents with shortness of breath and tachycardia. Cor pulmonale is a heart disorder that occurs because of lung disease. The lungs are dysfunctioning which causes hypoxia and reflex pulmonary artery vasoconstriction. The right ventricle has to eject blood into the pulmonary artery, however, there is high afterload to deal because of pulmonary vasoconstriction. The high workload against the right ventricle eventually causes the right ventricle to fail. This right ventricular failure because of lung disease is called cor pulmonale.

Answer to Question 2

ANS: B
The physical examination includes measurement of height and weight to calculate body mass index (BMI). The formula for calculating BMI is wt(kg)/ht(m2). A waist/hip ratio is also an indicator for risk of heart disease. A ratio greater than 0.85 for women and greater than 0.95 for men is considered to place individuals at increased risk, especially if accompanied by hyperinsulinemia or diabetes. These are part of a constellation of symptoms termed metabolic syndrome that indicates the greatest risk for the development of heart disease.